Case and Research Letter
Sarcoidal Necrobiosis Lipoidica in a Nondiabetic Patient: Usefulness of Skin Ultrasound
Necrobiosis lipoídica sarcoidea en paciente no diabético. Utilidad de la ecografía cutánea
a Clínica Pérez & Gavín dermatólogos, Vigo, Pontevedra, Spain
b Departamento de Dermatología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
c Departamentos de Radiología y Dermatología, Instituto de Investigación y Diagnóstico por Imágenes en Piel y Tejidos Blandos (IDIEP), Clínica Servet, Facultad de Medicina, Universidad de Chile, Santiago, Región Metropolitana, Chile
Leído
5427
Vecesse ha leído el artículo
1748
Total PDF
3679
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219016300786" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.05.008" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "1374" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:525-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 811 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 572 "PDF" => 184 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731016000946" "issn" => "00017310" "doi" => "10.1016/j.ad.2016.01.011" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "1374" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:525-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 284 "formatos" => array:3 [ "EPUB" => 4 "HTML" => 231 "PDF" => 49 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Necrobiosis lipoídica sarcoidea en paciente no diabético. Utilidad de la ecografía cutánea" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "525" "paginaFinal" => "527" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Sarcoidal Necrobiosis Lipoidica in a Nondiabetic Patient: Usefulness of Skin Ultrasound" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2005 "Ancho" => 1583 "Tamanyo" => 365035 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A) Ecografía <span class="elsevierStyleItalic">power</span>-Doppler (sonda lineal 15<span class="elsevierStyleHsp" style=""></span>MHz; eje longitudinal, pierna izquierda). Áreas hipoecoicas localizadas en dermis media e inferior (marcado con flecha), con difuminación del límite dermo-hipodérmico e incremento difuso de la ecogenicidad del tejido adiposo hipodérmico superficial subyacente; con <span class="elsevierStyleItalic">power</span>-Doppler se observa incremento del flujo dérmico e hipodérmico superficial. La imagen permite comparar la zona afecta (lado derecho de la imagen) con la piel sana perilesional (lado izquierdo de la imagen). B) Ecografía en escala de grises (sonda lineal 18<span class="elsevierStyleHsp" style=""></span>MHz; eje longitudinal, pierna izquierda). Bandas verticales hipoecoicas que se corresponden con los septos engrosados (marcado con flechas).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. García-Gavín, L. Comba Pérez-Pérez, L. Requena, X. Wortsman" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "García-Gavín" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Comba Pérez-Pérez" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Requena" ] 3 => array:2 [ "nombre" => "X." "apellidos" => "Wortsman" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219016300786" "doi" => "10.1016/j.adengl.2016.05.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300786?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016000946?idApp=UINPBA000044" "url" => "/00017310/0000010700000006/v1_201606280028/S0001731016000946/v1_201606280028/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219016300889" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.05.018" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "1353" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:527-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 989 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 792 "PDF" => 148 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Can Psoriasis Produce Irreversible Alopecia?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "527" "paginaFinal" => "530" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿La psoriasis produce alopecia irreversible?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 628 "Ancho" => 1750 "Tamanyo" => 255930 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Bilateral parietal and temporal alopecic plaques.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Gutiérrez García-Rodrigo, R. Rivera Díaz, F. Vanaclocha Sebastián, J.L. Rodríguez Peralto" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Gutiérrez García-Rodrigo" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Rivera Díaz" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha Sebastián" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Rodríguez Peralto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731016000661" "doi" => "10.1016/j.ad.2016.01.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016000661?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300889?idApp=UINPBA000044" "url" => "/15782190/0000010700000006/v2_201704050141/S1578219016300889/v2_201704050141/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016300774" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.05.007" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "1308" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2016;107:524" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1510 "formatos" => array:3 [ "EPUB" => 74 "HTML" => 1266 "PDF" => 170 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Dermatology</span>" "titulo" => "Pulsatile Supraclavicular Skin Tumor" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "524" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración cutánea pulsátil supraclavicular" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 750 "Ancho" => 784 "Tamanyo" => 59134 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Ferrándiz-Pulido, J. Juan, V. Pineda" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Ferrándiz-Pulido" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Juan" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Pineda" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015005098" "doi" => "10.1016/j.ad.2015.03.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015005098?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300774?idApp=UINPBA000044" "url" => "/15782190/0000010700000006/v2_201704050141/S1578219016300774/v2_201704050141/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Sarcoidal Necrobiosis Lipoidica in a Nondiabetic Patient: Usefulness of Skin Ultrasound" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "525" "paginaFinal" => "527" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. García-Gavín, L. Comba Pérez-Pérez, L. Requena, X. Wortsman" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "García-Gavín" "email" => array:2 [ 0 => "jgavin@pgdermatologos.com" 1 => "juangavin@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Comba Pérez-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Requena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "X." "apellidos" => "Wortsman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Clínica Pérez & Gavín dermatólogos, Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamentos de Radiología y Dermatología, Instituto de Investigación y Diagnóstico por Imágenes en Piel y Tejidos Blandos (IDIEP), Clínica Servet, Facultad de Medicina, Universidad de Chile, Santiago, Región Metropolitana, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Necrobiosis lipoídica sarcoidea en paciente no diabético. Utilidad de la ecografía cutánea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1066 "Ancho" => 990 "Tamanyo" => 169185 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, round and oval plaques affecting the anterior aspect of both lower legs. B, Detail of an isolated erythematous lesion, with orange, yellowish, brownish, and whitish areas; superficial atrophy and numerous telangiectasias can be observed. C, Dermoscopic image showing a dense network of branching anastomosing vessels on a yellow-orange background with whitish areas.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Necrobiosis lipoidica is a granulomatous disease of unknown origin that typically gives rise to multiple lesions on the anterior aspect of both lower legs. The histopathologic abnormalities are mainly observed in the mid and deep dermis. The alterations tend to extend into the subcutaneous cellular tissue along the adipose tissue septa, giving rise to a predominantly septal panniculitis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">High-frequency skin ultrasound has been shown to be a useful additional test for the diagnosis and differentiation of inflammatory diseases that affect the dermis and subcutaneous cellular tissue.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0015" class="elsevierStylePara elsevierViewall">Our patient was a 40-year-old woman with a history of systemic lupus erythematosus, with lupus nephritis diagnosed in 1997 (currently asymptomatic and not on treatment) and nonspecific colitis diagnosed in 2010 (on treatment with sulfasalazine). She was seen for asymptomatic lesions on the lower legs. The alterations had started 2 years earlier as a single lesion on the anterior aspect of left lower leg and had later affected the right lower limb. Dermoscopic study of 1 of the lesions (FotoFinder Medicam 800HD, FotoFinder Systems GmbH, Bad Birnbach, Germany) revealed a dense network of branching anastomosing vessels on a yellow-orange background (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Ultrasound was performed using the LOGIQ E9 XDclear device (General Electric Health Systems, Milwaukee, United States) with 2 linear transducers with maximum frequencies of 15 and 18<span class="elsevierStyleHsp" style=""></span>MHz. Hypoechoic areas were observed in the mid and deep dermis, with evidence of increased blood flow on color power Doppler. Compared with healthy perilesional skin, the dermohypodermal interface was blurred as a result of a diffuse increase in echogenicity of the subcutaneous cellular tissue (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). At greater depth, vertical hypoechoic bands were seen to penetrate deeply into the fat (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Histopathology revealed areas of degenerated collagen surrounded by palisaded histiocytes and a lymphocytic and plasma-cell infiltrate that mainly affected the mid and deep dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A). The inflammatory changes extended into the subcutaneous cellular tissue, with foci of degenerated collagen surrounded by histiocytes in the connective tissue septa of the hypodermis, forming granulomas of vaguely sarcoid appearance (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">A diagnosis of sarcoidal necrobiosis lipoidica was made and blood tests were requested, including measurement of blood glucose, thyroid hormones, and antithyroid antibodies, which were normal or negative. Treatment was started with topical corticosteroids.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">This case illustrates the usefulness of high-frequency ultrasound to guide the diagnosis in suspected necrobiosis lipoidica. The technique enables us to locate foci of inflammation in the mid and deep dermis, and to demonstrate the presence of panniculitis with edema and thickening of the septa in the subcutaneous cellular tissue. Dermal inflammation is seen as hypoechoic areas that usually have increased blood flow on color Doppler or power Doppler (slow flow). The inflammatory findings in the subcutaneous cellular tissue vary depending on whether involvement is predominantly lobular, septal, or mixed. Lobular involvement produces a diffuse increase in echogenicity of the adipose tissue; septal involvement produces a typically hypoechoic noncompressible thickening of the septa, seen as hypoechoic perilobular bands. In mixed panniculitis, the 2 patterns coexist.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In our patient, we also observed the characteristic loss of sharpness of the dermohypodermal junction, which we believe to be due to the simultaneous inflammatory involvement of the deep reticular dermis and the hypodermis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dermoscopy in our patient was characteristic. The lesions presented hairpin vessels on a yellowish-orange background with whitish areas. Branching vascular structures are formed of anastomosing vessels of a similar size. The presence of comma vessels has also been described as an early manifestation of the disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A pigmented pseudonetwork and a brown-colored background due to melanocyte stimulation are sometimes observed.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The case presented occurred in a nondiabetic patient with a diagnosis of systemic lupus erythematosus and nonspecific colitis. The association of necrobiosis lipoidica and diabetes mellitus is well known, but the proportion of patients who present both diseases varies between the different studies (11% to 65%).<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6–8</span></a> Necrobiosis lipoidica has also been reported in healthy individuals and in patients with other autoimmune and inflammatory diseases, including inflammatory bowel disease.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally, the finding on histopathology of sarcoid granulomas in the dermis and in the adipose tissue septa was interesting. These structures, formed of groups of giant and epithelioid cells in areas of degenerated collagen, are an uncommon feature that defines what has been called the sarcoid variant of necrobiosis lipoidica.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Gavín J, Comba Pérez-Pérez L, Requena L, Wortsman X. Necrobiosis lipoídica sarcoidea en paciente no diabético. Utilidad de la ecografía cutánea. Actas Dermosifiliogr. 2016;107:525–527.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1066 "Ancho" => 990 "Tamanyo" => 169185 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Well-defined, round and oval plaques affecting the anterior aspect of both lower legs. B, Detail of an isolated erythematous lesion, with orange, yellowish, brownish, and whitish areas; superficial atrophy and numerous telangiectasias can be observed. C, Dermoscopic image showing a dense network of branching anastomosing vessels on a yellow-orange background with whitish areas.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1203 "Ancho" => 950 "Tamanyo" => 188333 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Power Doppler ultrasound (linear 15<span class="elsevierStyleHsp" style=""></span>MHz transducer; longitudinal axis, left leg): hypoechoic areas in the mid and deep dermis (arrow), with blurring of the dermohypodermal junction and a diffusely increased echogenicity of the underlying superficial hypodermal adipose tissue. Power Doppler shows increased dermal and superficial hypodermal flow. The image allows us to compare the affected area (right side of the image) with healthy perilesional skin (left side of the image). B, Gray-scale ultrasound (linear 18<span class="elsevierStyleHsp" style=""></span>MHz transducer; longitudinal axis, left leg). The hypoechoic vertical bands correspond to thickened septa (arrows).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 595 "Ancho" => 1601 "Tamanyo" => 437052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A, Predominant involvement of the mid and deep dermis, with areas of degenerated collagen surrounded by palisaded histiocytes and a lymphocytic and plasma-cell infiltrate. B, The inflammatory changes extend into the subcutaneous cellular tissue, with foci of degenerated collagen surrounded by histiocytes in the connective tissue septa, forming granulomas of vaguely sarcoid appearance.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on necrobiosis lipoidica: A review of etiology, diagnosis, and treatment options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.D. Reid" 1 => "B. Ladizinski" 2 => "K. Lee" 3 => "A. Baibergenova" 4 => "A. Alavi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2013.05.034" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2013" "volumen" => "69" "paginaInicial" => "783" "paginaFinal" => "791" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23969033" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normal subcutaneous fat, necrosis of adipocytes and classification of the panniculitides" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.sder.2007.02.001" "Revista" => array:6 [ "tituloSerie" => "Semin Cutan Med Surg" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "66" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17544956" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory diseases of the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "X. Worstman" 1 => "L. Carreño" 2 => "C. Morales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Dermatologic ultrasound with clinical and histologic correlations" "paginaInicial" => "73" "paginaFinal" => "118" "serieFecha" => "2013" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermoscopy of necrobiosis lipoidica and granuloma annulare" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Pellicano" 1 => "G. Caldarola" 2 => "P. Filabozzi" 3 => "I. Zalaudek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000350573" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2013" "volumen" => "226" "paginaInicial" => "319" "paginaFinal" => "323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23797090" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatoscopia de la necrobiosis lipoídica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Conde-Montero" 1 => "J.A. Avilés-Izquierdo" 2 => "M.D. Mendoza-Cembranos" 3 => "V. Parra-Blanco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.07.017" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "534" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23084882" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrobiosis lipoidica: Only a minority of patients have diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.A. O’Toole" 1 => "U. Kennedy" 2 => "J.J. Nolan" 3 => "M.M. Young" 4 => "S. Rogers" 5 => "L. Barnes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1999" "volumen" => "140" "paginaInicial" => "283" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10233223" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on clinical and laboratory features in necrobiosis lipoidica: A retrospective multicentre study of 52 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Erfurt-Berge" 1 => "A.T. Seitz" 2 => "C. Rehse" 3 => "U. Wollina" 4 => "K. Schwede" 5 => "R. Renner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1684/ejd.2012.1839" "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2012" "volumen" => "22" "paginaInicial" => "770" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23114030" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrobiosis lipoídica. Estudio descriptivo de 35 pacientes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Marcoval" 1 => "S. Gómez-Armayones" 2 => "F. Valentí-Medina" 3 => "M. Bonfill-Ortí" 4 => "L. Martínez-Molina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2015.01.004" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2015" "volumen" => "106" "paginaInicial" => "402" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25728565" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The many faces of necrobiosis lipoidica: A report of three cases with histologic variations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P-S. Yen" 1 => "K-H. Wang" 2 => "W-Y. Chen" 3 => "Y-W. Yang" 4 => "W-T. Ho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatologica Sinica" "fecha" => "2011" "volumen" => "29" "paginaInicial" => "67" "paginaFinal" => "71" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrobiosis lipoídica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Dermatopatología: Correlación Clínico Patológica" "paginaInicial" => "401" "paginaFinal" => "404" "serieFecha" => "2007" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000006/v2_201704050141/S1578219016300786/v2_201704050141/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000006/v2_201704050141/S1578219016300786/v2_201704050141/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016300786?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 10 | 16 |
| 2024 Octubre | 70 | 43 | 113 |
| 2024 Septiembre | 66 | 21 | 87 |
| 2024 Agosto | 106 | 44 | 150 |
| 2024 Julio | 100 | 31 | 131 |
| 2024 Junio | 108 | 56 | 164 |
| 2024 Mayo | 105 | 43 | 148 |
| 2024 Abril | 81 | 27 | 108 |
| 2024 Marzo | 64 | 22 | 86 |
| 2024 Febrero | 80 | 29 | 109 |
| 2024 Enero | 68 | 38 | 106 |
| 2023 Diciembre | 63 | 22 | 85 |
| 2023 Noviembre | 86 | 23 | 109 |
| 2023 Octubre | 63 | 15 | 78 |
| 2023 Septiembre | 75 | 30 | 105 |
| 2023 Agosto | 44 | 18 | 62 |
| 2023 Julio | 62 | 37 | 99 |
| 2023 Junio | 111 | 29 | 140 |
| 2023 Mayo | 96 | 23 | 119 |
| 2023 Abril | 61 | 16 | 77 |
| 2023 Marzo | 50 | 26 | 76 |
| 2023 Febrero | 52 | 25 | 77 |
| 2023 Enero | 36 | 39 | 75 |
| 2022 Diciembre | 50 | 32 | 82 |
| 2022 Noviembre | 34 | 23 | 57 |
| 2022 Octubre | 26 | 23 | 49 |
| 2022 Septiembre | 25 | 30 | 55 |
| 2022 Agosto | 15 | 41 | 56 |
| 2022 Julio | 32 | 31 | 63 |
| 2022 Junio | 23 | 23 | 46 |
| 2022 Mayo | 83 | 28 | 111 |
| 2022 Abril | 54 | 33 | 87 |
| 2022 Marzo | 47 | 41 | 88 |
| 2022 Febrero | 54 | 23 | 77 |
| 2022 Enero | 85 | 36 | 121 |
| 2021 Diciembre | 40 | 34 | 74 |
| 2021 Noviembre | 46 | 41 | 87 |
| 2021 Octubre | 57 | 39 | 96 |
| 2021 Septiembre | 58 | 41 | 99 |
| 2021 Agosto | 47 | 23 | 70 |
| 2021 Julio | 23 | 17 | 40 |
| 2021 Junio | 60 | 27 | 87 |
| 2021 Mayo | 54 | 39 | 93 |
| 2021 Abril | 108 | 69 | 177 |
| 2021 Marzo | 60 | 17 | 77 |
| 2021 Febrero | 55 | 25 | 80 |
| 2021 Enero | 41 | 15 | 56 |
| 2020 Diciembre | 42 | 8 | 50 |
| 2020 Noviembre | 24 | 16 | 40 |
| 2020 Octubre | 27 | 17 | 44 |
| 2020 Septiembre | 38 | 12 | 50 |
| 2020 Agosto | 36 | 19 | 55 |
| 2020 Julio | 23 | 14 | 37 |
| 2020 Junio | 29 | 20 | 49 |
| 2020 Mayo | 17 | 13 | 30 |
| 2020 Abril | 21 | 14 | 35 |
| 2020 Marzo | 17 | 13 | 30 |
| 2020 Febrero | 3 | 0 | 3 |
| 2019 Diciembre | 2 | 0 | 2 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Junio | 2 | 0 | 2 |
| 2019 Mayo | 1 | 0 | 1 |
| 2019 Abril | 0 | 2 | 2 |
| 2019 Marzo | 2 | 2 | 4 |
| 2019 Febrero | 1 | 0 | 1 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 25 | 2 | 27 |
| 2018 Enero | 41 | 10 | 51 |
| 2017 Diciembre | 48 | 6 | 54 |
| 2017 Noviembre | 38 | 6 | 44 |
| 2017 Octubre | 32 | 7 | 39 |
| 2017 Septiembre | 30 | 3 | 33 |
| 2017 Agosto | 34 | 6 | 40 |
| 2017 Julio | 28 | 5 | 33 |
| 2017 Junio | 47 | 8 | 55 |
| 2017 Mayo | 36 | 10 | 46 |
| 2017 Abril | 45 | 10 | 55 |
| 2017 Marzo | 19 | 12 | 31 |
| 2017 Febrero | 21 | 7 | 28 |
| 2017 Enero | 25 | 6 | 31 |
| 2016 Diciembre | 30 | 19 | 49 |
| 2016 Noviembre | 20 | 40 | 60 |
| 2016 Octubre | 28 | 20 | 48 |
| 2016 Julio | 2 | 3 | 5 |
Mostrar todo
